Pulmonary lymphangitic carcinomatosis: CT and pathologic findings

The authors retrospectively reviewed the computed tomographic (CT) scans, biopsy specimens, autopsy results, and lobectomy specimens of 21 patients who had lymphangitic carcinomatosis. Ten-millimeter collimation CT scans were obtained from all patients, and selected 1.5-mm CT scans were obtained from ten patients. In five patients, the diagnosis was established with open lung biopsy, lobectomy, or autopsy; in nine, with bronchial biopsy or transbronchial biopsy; and in seven, with clinical and radiologic criteria. Certain characteristic findings on CT scans were evident: uneven thickening of bronchovascular bundles, thickening of isolated interstitial lines, and the presence of polygonal lines. These findings may be seen on CT scans even if the findings on chest radiographs are normal or nonspecific. The pathologic basis for these characteristic CT findings may relate to tumor thrombi in lymphatic vessels rather than edema and fibrosis, at least in the early stages of disease.     

心房扑动患者的下腔静脉-三尖瓣环峡部和房间隔缓慢传导的电生理意义

目的　用电 解剖标测方法标测右心房 ,然后比较心房扑动 (AFL)和房室结折返性心动过速(AVNRT)患者在下腔静脉 三尖瓣环峡部 (CTI)和心房间隔部 (AS)的电冲动传导速度 ,以便确定AFL患者除了解剖结构上的异常外 ,是否伴有心房电生理方面的异常变化。方法　 1 0例AFL患者 ,男性 7例 ,女性 3例 ,平均 (53± 1 0 )岁 ;1 3例AVNRT患者 ,男性 5例 ,女性 8例 ,平均 (51± 1 1 )岁。对这两组患者进行了详细的电 解剖标测、电生理检查和射频消融术。分别以周长为 60 0、40 0、和 30 0ms在冠状静脉窦 (CS)起搏的情况下测量AFL和AVNRT患者的CTI和AS的冲动传导速度 ,并将两组患者在CTI和AS的冲动传导速度进行比较。结果　与AVNRT患者相比 ,AFL患者在各个起搏周长 (PCL)时CTI和AS的冲动传导速度都明显减慢 (P <0 0 5)。另外 ,在AFL组 ,AS的冲动传导速度在起搏周长 60 0、40 0ms时低于CTI,但在 30 0ms时差异无显著性 (P >0 0 5)。因为在AFL组 ,PCL为 30 0ms时的冲动传导速度明显低于 60 0和 40 0ms时的冲动传导速度 ,致使PCL为 30 0ms时CTI和AS的冲动传导速度差异无显著性。结论　与CTI相比 ,AS的冲动传导速度在所有患者都较慢 ,而AFL患者在CTI和AS的冲动传导速度减低更明显 ,并且在CTI的冲动传导速度减慢具有频率依     

Pulmonary alveolar proteinosis: CT findings

In pulmonary alveolar proteinosis (PAP), a proteinaceous material accumulates in the alveolar air spaces, causing hypoxemia, restrictive lung disease, and dramatic abnormalities on chest radiographs. Complications are unusual, but of the ones that do occur, infection, particularly with Nocardia asteroides, and fibrosis are the most common. Few computed tomographic (CT) studies of this condition have been reported. The CT scans of nine patients with PAP were reviewed. Varying combinations of air-space and interstitial patterns were seen. The CT appearance of air-space disease ranged from ill-defined nodules to patchy consolidation to large regions of confluence. Air-space consolidation was sometimes sharply demarcated from surrounding normal lung tissue, which created a geographic pattern. Despite the predominance of air-space patterns, air bronchograms were not a prominent feature. CT showed the interstitial component of disease and the extent of disease more clearly than did plain radiography. In two cases, CT demonstrated focal pneumonia that was not visible on the radiographs.     

Six- and Twelve-Month Abstinence Rates in Inpatient Alcoholics Treated with Aversion Therapy Compared with Matched Inpatients from a Treatment Registry

Two hundred forty-nine patients who were treated for alcoholism in an inpatient multimodal treatment program that included aversion therapy were matched post hoc on 17 baseline variables with patients from a national treatment outcome registry. The latter patients received inpatient treatment that emphasized individual and group counseling as the primary therapeutic elements but did not include aversion therapy for alcohol. Six- and 12-month abstinence rates from alcohol and all mood-altering chemicals are reported. The patients treated with aversion therapy for alcohol had higher alcohol abstinence rates at 6 and 12 months (p less than 0.01). The abstinence rates from all mood-altering chemicals were higher in the aversion group at 6 months (p less than 0.05) but not at 12 months. The largest differences between treatment groups in 6-month alcohol abstinence rates were noted for males (p less than 0.001), those over 35 (p less than 0.001), daily drinkers (p less than 0.001), and those with alcohol-related work performance problems (p less than 0.05).     

The effect of breast self-exam practices and physician examinations on extent of disease at diagnosis

To determine the relation between breast self-exam (BSE) practices and detection of tumors, a sample of 230 breast cancer patients from a population-based cancer registry in Washington State were interviewed during 1977–1978. Patients practicing BSE were significantly more likely to find their own tumors than patients not practicing BSE (80 vs 67%, P = 0.047). Yet, in contrast to other studies, no statistically significant associations were found between method of detection and extent of disease as measured by stage, tumor size, or number of lymph nodes involved. Nor did other covariates—demographic factors, menopausal status, and histology—alter the relation between BSE and extent of disease. Methodologic comparisons between the major studies and suggestions for future research were made to clarify the inconsistent evidence of the benefits from breast self-exam on extent of disease.